Queen Essays

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Nhazanu Yekeh Pessima

AUT 540 Module 3

Applied Project 1

June 18, 2023

Skill: Hand Washing

The importance of Hand Washing

Hand washing hands regularly using running water is essential to any individual. Keeping hands clean kills bacteria and germs, which cause diseases such as COVID-19 and diarrhea. Fewer people are admitted to the hospital due to these illnesses. In schools, washing hands is important, and this skill should be continuously practiced enabling learners to become responsible and dependable. They habitually wash their hands after eating and visiting the toilet. In the early stages of development of a child, washing hands helps a child develop cognitive concepts and ideas, making them grow in the right manner. I chose to teach the concept of handwashing to educate individuals and the public on preventive measures against some emerging diseases. Most importantly, the topic aims to improve the community's hygienic levels.

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AUT 540

Handwashing References

Nhazanu Yekeh Pessima

Graduate School College of Education, Endicott College,

AUT 540 : AT01-SU23 ADOLESCENTS AND ADULTS WITH ASD

Professor. Gloria Satriale

June 30, 2023

References

Agaro, A., Hareru, H. E., Muche, T., Sisay W/tsadik, D., Ashuro, Z., Negassa, B., Legesse, M. T., Kaso, A. W., Alemu, W., Alemayehu Gube, A., Aregu, M. B., & Soboksa, N. E. (2022). Predictors of hand-washing practices at critical times among mothers of under-5 years old children in rural setting of Gedeo Zone, southern Ethiopia. Environmental Health Insights, 16, 117863022211207. https://doi.org/10.1177/11786302221120784

Ayran, G., Köse, S., Sarıalioğlu, A., & Çelebioğlu, A. (2022). Hand hygiene and mask-wearing behaviors and the related factors during the COVID 19 pandemic: A cross-sectional study with secondary school students in Turkey. Journal of Pediatric Nursing, 62, 98–105. https://doi.org/10.1016/j.pedn.2021.10.001

Bugis, B., & Chandramohan, S. (2022). Behaviors and associated factors of hand hygiene and mask-wearing among higher education students during the COVID-19 pandemic: A cross-sectional study from Kingdom of Saudi Arabia. Majmaah Journal of Health Sciences, 10(3), 34. https://doi.org/10.5455/mjhs.2022.03.005

Gião, M. S., & Vardoulakis, S. (2022). Aerosols and bacteria from hand washing and drying in indoor air. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.804825

Idris, I., Nursiah, A., Syarif, I., & Latif, Y. (2022). Handwashing with soap counseling (CTPS) on children’s knowledge and attitudes in the era of the COVID-19 pandemic. Jurnal Ilmiah Kesehatan (JIKA), 4(2), 252–258. https://doi.org/10.36590/jika.v4i2.354

Nuzul Ulpa, A., & Djuari, L. (2023). The effect of health promotion on clean and Healthy Living Behavior(CHLB) “handwashing with soap” to school children using various methods and media. International Journal of Research Publications, 117(1). https://doi.org/10.47119/ijrp1001171120234438

Sedekia, Y., Kapiga, S., Mcharo, O., Makata, K., Torondel, B., Dreibelbis, R., & Okello, E. (2022). Does a school-based intervention to engage parents change opportunity for handwashing with soap at home? practical experience from the Mikono Safi trial in Northwestern Tanzania. PLOS Neglected Tropical Diseases, 16(6). https://doi.org/10.1371/journal.pntd.0010438

Umar, H., Geremew, A., Worku Kassie, T., Dirirsa, G., Bayu, K., Mengistu, D. A., Berhanu, A., & Mulat, S. (2022). Hand hygiene compliance and associated factor among nurses working in public hospitals of Hararghe Zones, Oromia Region, eastern Ethiopia. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1032167

Wahl, K., Scholl, P. M., Wirth, S., Miché, M., Häni, J., Schülin, P., & Lieb, R. (2022). On the automatic detection of enacted compulsive hand washing using commercially available wearable devices. Computers in Biology and Medicine, 143, 105280. https://doi.org/10.1016/j.compbiomed.2022.105280

White, S., Mutula, A. C., Buroko, M. M., Heath, T., Mazimwe, F. K., Blanchet, K., Curtis, V., & Dreibelbis, R. (2022). How does handwashing behavior change in response to a cholera outbreak? A qualitative case study in the Democratic Republic of the Congo. PLOS ONE, 17(4). https://doi.org/10.1371/journal.pone.0266849

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Handwashing

AUT 540 M1

Applied Project 3 – Intro/Lit Review (Handwashing)

Nhazanu Yekeh Pessima

Graduate School College of Education, Endicott College,

AUT 540 : AT01-SU23 ADOLESCENTS AND ADULTS WITH ASD

Professor. Gloria Satriale

July 9, 2023

Hand washing is an important skill that applies to all individuals living in society starting from toddlers, school-going children, adolescents, and adults. Most importantly, his paper focuses on the importance of this skill to learners with autism spectrum disorder.(ASD). It involves using soap and clean water to kill accumulated germs in the hands. After every task which involves touching surfaces, learners with ASD need to wash their hands for the benefit of their healthy well-being. In school, learners must wash their hands after visiting toilets, after class activities, and before taking meals. Teachers should therefore take the role of educating them on how to implement the skill at all levels of learning. Common defects associated with failure to wash hands include the spread of deadly diseases such as diarrhea and COVID-19. Eating before washing hands creates pathways for germs into the human body. Through this, an interruption of normal digestion is realized leading to this illness which is dangerous to these learners. Alternatively, it may lead to the accumulation of germs in common surfaces surrounding the living environment like the door grills, tables, playing objects, and window grills. Interaction with other learners leads to the spread of germs through contact. The COVID-19 pandemic is another common deficit associated with inadequate washing of hands. The germs easily navigate from one individual to another hence increasing the number of deaths in the global society. To avoid this increase, learners with ASD should be educated on the need to frequently wash their hands with running water.

Respiratory diseases are likely to emerge due to the failure to wash hands. This occurs when the learners affected with ASD touch their eyes, nose, and mouth creating passages for the germs. As a result, they interfere with the functioning of these organs leading to defects and conditions which require medical attention. People are therefore advised to avoid touching their critical body parts without any consent. Touching foods such as fruits without cleaning hands leads to stomach upsets. Germs are carried to the stomach and upon interacting with other body fluids, they multiply and lead to complications. Failure to observe hygiene in terms of hand washing leads to negative impacts on the target group. Firstly, there is an outbreak of disease that affects their performance in school, work, and society. Learners with ASD who are affected with these diseases develop low concentration in class leading to poor memory and retention of knowledge and skills. On the other hand, adolescents in higher levels of education drop out failing to fulfill their career desires. This contributes to the increased unskilled workforce which affects the general quality of life since there is insufficient money to fulfill the daily needs. Struggles to get basic needs lead to high poverty levels affecting the economy of a country.

Educating learners with ASD on the skill of hand washing is important to them in a variety of ways. They become responsible for their health by maintaining high hygiene levels in and outside school. The ability to practice this aspect of health in their daily life while in school makes them responsible individuals in society. Most importantly, the acquired knowledge and skills are applied in a society where the members are educated on the need to keep their hands clean in all circumstances. The number of admitted patients in the hospital reduces drastically since they take earlier preventive measures so that they do not contact hospital acquire diseases. Healthy learners stay in school for a long time, hence improving their performance. In universities, learners spend most of their time in school sharpening their skills which helps them secure future jobs. After getting their salary, they can live lives of their choice.

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AUT 540 M8

AUT 540 M8 Handwashing Literature Review.

Nhazanu Yekeh Pessima

Graduate School College of Education, Endicott College,

AUT 540 : AT01-SU23 ADOLESCENTS AND ADULTS WITH ASD

Professor. Gloria Satriale

July 23, 2023

Applies Project: Hand Washing

The targeted skill was handwashing, and a variety of interventions will be used while teaching the skill. Hand washing involves the use of soap and running water to kill the accumulated germs likely to cause disease. According to (Praiwa and Negara, 2022) “Washing hands with soap can kill 73% of germs and is more effective at killing germs than using a hand sanitizer which only kills 60% of germs ". This skill is implemented because of continuous training of the young school-going children where they must be educated on how to perform it. Further, in a school setup, there should be available facilities such as taps that have been installed safely for easy access. The teachers in the school environment should offer the necessary support to learners who have not yet mastered the skill for efficiency. They should encourage the students to adopt the habit of washing hands after visiting the toilet, playing, and before eating meals. Research conducted implies that inadequate skills and knowledge in elementary schools are a result of inadequate training from the relevant authorities.

Hand-washing skills are effective when the application of detergents that kill germs is used. For instance, liquid soaps which contain some chemicals for killing germs are advisable. In a school setup, the Ministry of health in various countries has made efforts to provide learners with the required resources (Lao et al., 2023). This has reduced the number of students admitted to hospitals due to diseases like diarrhea. They have spent more time in school, hence concentrating and as a result, improved performance has been realized. Institutions that have developed and implemented the use of technology can use automated machines to wash their hands. Since the emergency of the COVID-19 pandemic globally, most individuals have died due to the disease. However, handwashing techniques were invented to deal with preventive measures. In this intervention, blended learning has been realized with practical accompany theory learning. A machine that has an IR sensor component that can automatically switch on and off is used. The presence of the hand influences the working of the device. This has made work easier and save time for learners in school. "In demonstrating the tool there is a percentage of students with a positive response where as many as 14 students state very good with a percentage of 66.67%, and as many as 4 people state good with a presentation of 19% and as many as 3 people state quite well with a percentage of 14% (Satria e al., 2022). “This has demonstrated the need to adopt current technology in making work easier and timesaving.

The final step for handwashing is drying the hands to remove excess water which may make one uncomfortable. According to (Gião and Vardoulakis, 2022) “Effective hand drying is an important part of hand hygiene that can reduce the risk of infectious disease transmission through cross-contamination of surfaces by wet hands.” While at school, learners can be guided on how to improvise hand-drying items by using locally available materials to save on expenses. Additionally, parents should make some efforts to purchase the items if they are in a position to do so. The research conducted performed a practical demonstration to examine the impact of using different hand dryers. Results implied that bacteria and aerosol concentration increase when individuals under the controlled experiment enter and wash their hands. Further, an increase was realized during the hand drying procedure. A preference was made for jet hair dryers when compared to towel ones. A proper method of washing hands aims at removing the accumulated germs and bacteria which are harmful to the human body.

References

Gião, M. S., & Vardoulakis, S. (2022). Aerosols and bacteria from hand washing and drying in indoor air.  Frontiers in Public Health,  10, 804825.

Lao, C. K., Li, X., Zhao, N., Gou, M., & Zhou, G. (2023). Using the health action process approach to predict facemask use and hand washing in the early stages of the COVID-19 pandemic in China.  Current Psychology,  42(8), 6484-6493.

Pratiwi, E., & Negara, C. K. (2022). The Effect of Health Education Of Children's Song Animations On Knowledge Of Hand Washing With Soap (Ctps) School Age Children During The Covid-19 Pandemic In Gembolngawi Village.  Journal Of Educations,  1(1).

Satria, H., Nasution, M., Mungkin, M., Anisa, Y., & Hardinata, A. (2022). Design and Demonstration of the Use of Automatic Hand Washing Sink Technology in Covid-19 Pandemic Conditions.  International Journal of Education, Information Technology, and Others,  5(2), 127-132.

Siregar, M. F., & Imam, C. (2022). Design Of Automatic Hand Washing System Using Solenoid Valve Based on Microcontroller.  INFOKUM,  10(03), 20-25.

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A Program to Increase Physical Activity for an Adolescent with Autism Spectrum Disorder and Down Syndrome

Introduction:

In “The Effect of Electronic Self-Monitoring on Weight Loss and Dietary Intake: A Randomized Behavioral Weight Loss Trial,” Emily E. Dunn and Jennifer Robertson-Wilson (2018) state that worldwide 3.2 million deaths annually are associated with physical inactivity. Beyond the health implications, leisure and recreation are associated with a higher quality of life providing opportunities for fun, social interactions, friendship, and dignity (Coyne & Fullerton, 2016). However, Coyne and Fullerton reference several studies reporting that children and adolescents with Autism Spectrum Disorder have significantly fewer recreation activities than their typically-developing peers, and the activities they do participate in are often passive. The authors speculate that individuals with Autism Spectrum Disorder may enjoy one or more of a variety of recreation activities is given the opportunity and choices to do so.

The goal of this applied project was to teach an adolescent diagnosed with Autism Spectrum Disorder and Down syndrome to incorporate regular fitness activities into his weekly routines. The program was comprised of two parts run simultaneously. Part One emphasized choice of activity and choice of reinforcer. Part Two involved self-monitoring through electronic tracking of physical activity.

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In a 2005, Rosanne Burton Smith, Michaela Morgan and John Davidson conducted a study to compare the opportunities for daily choice between typically developing individuals and those with intellectual disabilities with a survey of more than 250 participants ranging in age from 11 to 6 to assess what level of control participants had over their routine daily choices.

According to the authors, adults with intellectual disabilities have significantly less choice as decisions are often made for them by family members or professional support staff. The more severe the disability reflected an even greater restriction on choice (Burton Smith, Morgan, & Davidson, 2005). The opportunity to choose activities, tasks, order of activity and reinforcers have all been shown to increase effective behavior and reduce inappropriate behavior (Akerlund Brandt, Dozier, Foster Juanico, Laudont & Mick, 2015). Studies have found that when children with autism are given choice over one or more of these elements, they exhibit fewer occurrences of aggression and self-injurious behavior. A 2010 study assessed the effect of activity and material choice on on-task behavior for four boys, 5 to 8-years old with Autism Spectrum Disorder. The findings supported previous research indicating that choice of activity and materials increases appropriate and on-task behavior (Ulke-Kurkcuoglu & Kircaali-Iftar, 2010). Another study that examined the reinforcing effects of choice-making revealed that not only do most typically developing children identify independent choice as more reinforcing than having an adult make choices for them, the preference for independent choice-making is strengthened through conditioning, while a preference for accepting the options determined by someone else is not (Ackerlund Brandt et al., 2015). Another study involving four individuals, two of whom were diagnosed with pervasive developmental disorder and two with autism, found that for two of the participants, the choice-making opportunity itself functioned as a reinforcer (Sellers et al., 2013).

Electronic fitness trackers incorporate a variety of Behavior Change Techniques. This study will focus on the visual prompting of the pedometer function in the activity tracker. When the subject dons the wrist-worn fitness tracker, the device becomes a tactile and visual stimulus in the environment and serves as a self-monitoring device. (Sullivan, Alycia, Hawkins, J., & Middelweerd, A., 2019). Electronic self-monitoring devices allow that awareness to occur in real-time, something that is difficult to attain through paper journal methods. The study compared adherence to self-monitoring over a six-month period between dieters using a paper

record system and those using an electronic self-monitoring system. The participants in the paper record group were less adherent to self-monitoring. This may have been due to the tedious nature of a paper record requiring handwritten entries, as well as research for nutritional content of foods consumed (Burke, Conroy, Sereika, Elci, Styn, Acharya, Sevick, Ewing, & Glanz, 2011). Dunn and Robertson-Wilson (2011) cite the increase in an individual’s awareness of their behavior and the variables that influence that behavior as the benefits of self-monitoring. Eight- two percent of the participants in their Dunn study reported wearing their activity tracking device seven days a week, all 45 participants used their activity tracker to monitor steps, a widely- recognized quantification of activity, and the average daily step increase during the study was 2000 steps (2018).

Behavior to Increase

The target of this instruction was to increase physical activity as measured in duration (minutes) and total daily steps. Any increase is physical activity would benefit the subject, however, mastery was defined as a 50-percent increase in daily activity duration over five consecutive days and a 50-percent increase in total daily steps over five consecutive days.

Participant

The subject was a 15-year old male diagnosed with Autism Spectrum Disorder and Down syndrome. At age 5 ½ weeks, the subject underwent open-heart surgery for an Atrioventricular Septal Defect repair and PDA ligation. In addition, at age 7-days, he underwent an intestinal “pull-through” surgical procedure to remove an under-developed section of the colon due to Hirshprung Disease. While the subject maintains a healthy weight and diet, excess weight gain in the future could place undue stress on his heart. Furthermore, he experiences occasional constipation from low motility during periods of reduced physical activity. He has been cleared by his primary care physician, cardiologist, and orthopedist to engage in daily fitness activities including strength training, cardiovascular fitness activities, and stretching. He is restricted from contact sports, such as football, horseback riding, and wrestling, due to a risk of atlantoaxial instability. The subject’s parents express concern over the subject’s limited repertoire of physical activities due to recent school closures and requirements to remain in the home setting as a result of the COVID-19 pandemic.

Interventions

This program was implemented during a time when the family was restricted to home and neighborhood-based activities. The subject was following a loose daily schedule incorporating home-school and virtual-school academic programs, ADLs, cooking and household chores, and recreation. For Part One, teaching techniques included choice, self-monitoring, reinforcement, Premack Principle, and modeling. A laminated choice board allowed the learner to select activities and reinforcers for Part One of the program. A most-to-least prompting hierarchy was used wherein the instructor first gave a verbal prompt for the subject to select an activity. If the subject did not select an activity, the instructor presented a visual First and Next prompt. During

Part Two, the subject was prompted to don his fitness tracker in the morning and log the daily steps at the end of the day. The reinforcement schedule for Part One was Fixed Interval: During days 1-7, the student earned three minutes of screen time for each minute of activity. During days 8-14, he earned two minutes of screen time for each minute of activity. During days 15-31 and maintenance, the student earned one minute of screen time for each minute of activity. The reinforcement schedule for Part II was a fixed ratio wherein the student earned 50-cents for every day steps exceeded 2,500 and $1.00 for every day steps exceeded 5,000. For more information on the procedures, see the attached Procedure Manual (Appendix 1).

Data Collection

Data collection for Part One included total daily activity duration, selected activity, a social validity question response to assess if the student enjoyed the chosen activity, and confirmation the reinforcer was delivered by the parent. During Part Two data included total number of daily steps and if the associated reinforcer was earned and delivered.

Results

The subject reached mastery criteria for Part One on Day 15 (5/15/20) and for Part Two on Day 13 (5/13/20). Interestingly, the subject increased his activity duration to compensate for the thinning reinforcement schedule at both Day 9 and Day 16, two days after each respective reinforcement thinning went into effect. On Day 20, activity was significantly lower due to severe inclement weather and a power outage.

DURATION

Figure 1: Daily Activity Duration

Daily Activity Duration

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Future programs could include more choices that do not depend upon technology and allow more indoor and outdoor choices to replace the least selected activities such as Wii Exercise, Yoga, and Dance Video.

SELECTION COUNT

Figure 3: Activity Preference

Yoga

Walk/Run Dance Video

Superhero

Workout

ACTIVITY

Weights

Wii Exercise

Example

35

30

25

20

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10

5

0

Activity Preference Tracking

The subject selected Walk/Run most often which may be associated with his father’s interest in competitive running, as well as his own past experiences with Special Olympics and school-based track events. He and his father have both received medals for these activities that are displayed in the family room, so the subject likely finds walking and running contribute to a high level of happiness beyond the physical effects. Also, the family takes daily walks together which allowed the subject to quickly accumulate pedometer steps each day.

TOAL STEPS

Figure 2: Part Two – Daily Step Total

Daily Steps

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The data graphing does not clearly depict it, but the four days the participant stated he did not enjoy the activity were the four days he chose the Dance Video activity. This activity may have been too structured to be fun or involved too complex of gross motor movements for this participant.

COUNT

Figure 3: Social Validity – Was this fun?

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Yes

RESPONSE

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Conclusion

This program was successful in increasing the subject’s daily physical activity. By providing him with a wide selection of activity choices, the program capitalized on the findings of past studies that had proven choice to be effective at increasing participation and on-task behavior and reducing problem behaviors. The subject was included in various self-monitoring activities in the program, such as logging his daily steps and operating the timer for the various fitness activities. Future studies could strive for a higher level of independence in initiating the program steps and creating the field of activity options. Also, because daily activities were tallied for a total daily duration, there is no record of duration for individual activity, which would provide greater insight into the subject’s activity preferences.

References

Ackerlund Brandt, J. A., Dozier, C.L., Foster Juanico, J., Laudon, C. L. & Mick, B. R. (2015). The value of choice as a reinforcer for typically developing children. Journal of Applied Behavior Analysis, 48(2), 344-362.

Bannerman, D.J., Sheldon, J.B., Sherman, J.A., & Harchik, A.E. (1990). Balancing the right to habilitation with the right to personal liberties: The rights of people with developmental disabilities to eat too many doughnuts and take a nap. Journal of Applied Behavior Analysis, 23(1), 79-89.

Burke, L. E., Conroy, M.B., Sereika, S.M., Elci, O.U., Styn, M. A., Acharya, A. D. , Sevick, M.A., Ewing, L. J., & Glanz, K. (2011). The Effects of Electronic Self-Monitoring on Weight Loss and Dietary Intake: A Randomized Behavioral Weight Loss Trial. Obesity Journal, 19(2), 338-344.

Burton Smith, R., Morgan, M. & Davidson, J. (2005). Does the daily choice making of adults with intellectual disabilities meet the normalization principle? Journal of Intellectual and Developmental Disability, 30(4), 226-235.

Coyne, P. & Fullerton, A. (2014). Toward a Balanced Leisure Lifestyle for Adults with Autism Spectrum Disorders. In M. Tincani & A. Bondy. (Eds.), Autism Spectrum Disorders in Adolescents and Adults: Evidence-Based and Promising Interventions. (pp. 208-233). Guilford Press.

Dunn, E. E. & Robertson-Wilson, J. (2018). Behavior change techniques and physical activity using the Fitbit Flex. International Journal of Exercise Science, 11(7), 561-574.

Sellers, T. P., Bloom, S.E., Samaha, A.L., Dayton, E., Lambert, J. M. & Keyl-Austin, A.A.

(2013). Evaluation of some components of choice making. Journal of Applied Behavior Analysis, 46(2), 455-464.

Sullivan, Alycia, Hawkins, J., & Middelweerd, A. (2019). Behavior Change Techniques Incorporated in Fitness Trackers: Content Analysis. JMIR Mhealth Uhealth, 7(7), doi: 10.2196/12768.

Ulke-Kurkcuoglu, B. & Kircaali-Iftar, G. (2010). A comparison of the effects of providing activity and material choice to children with autism spectrum disorders. Journal of Applied Behavior Analysis, 43(4), 717-721.

Appendix 1: Procedure Manual

Procedure Manual

Goal: This two-part program is designed to increase daily fitness activity.

Teaching Techniques include:

· Choice – Learner will select from a variety of activities and reinforcers

· Self-monitoring – Learner will use wipe-off marker on laminated exercise choice board and time to self-monitor and self-report activity.

· Reinforcement – Part 1: Learner will earn preferred screen time activities. Part 2: Learner will earn a generalized conditioned reinforcer.

· Modeling – parents will implement a similar program to earn their tv time.

Part One Materials:

· Superhero Workout – Superhero Workout Visual

· Weights – Free weights and basic weight routine.

· Wii Exercise – Wii exercise discs, gaming system and television

· Yoga – Yoga Cards, yoga mat, strap and blocks

· Walk/Run – Sneakers and weather appropriate clothing

· Dance Video – Television with internet access

· Timer

· Dry-erase marker

· Exercise Choice Board

· First and Then Visual

· Data sheets and graphs

Part Two Materials:

· Electronic fitness tracker

· Data sheets and graphs

· $1.00 bills and coins totaling 50-cent and $1.00 increments

· Designated box for earned money

Reinforcers:

Part One:

· Television with internet access

· Wii or Switch gaming system with games Part Two:

· Money

Procedure Part One:

This program is being implemented during a time when the family is restricted to home and neighborhood-based activities. The subject is presently following a loose daily schedule incorporating home-school and virtual-school academic programs, ADLs, cooking and household chores, and recreation.

Step 1: Once between 8:00 a.m. and noon, and again between noon and 4:00 p.m., the subject will be prompted to use a dry-erase marker to choose an exercise activity from the Exercise choice board. If he refuses to participate, parent will present the First and Then visual incorporating the Premack Principle to prompt a response.

Step 2: The student selects the activity of choice.

Step 3: The student starts a timer and immediately begins that exercise. Parent will model all exercise activities and participate.

Step 4: When student stops activity and time, he writes the total number of minutes he exercised on the exercise choice board.

Step 5: Parent will ask social validity question, “Is this exercise fun?” and log the child’s yes or no response on the data collection sheet.

Step 6: Parent will offer the option of doing another or more of the same activity to earn more screen time. If the student says, “Yes,” repeat steps 2-4. If he says “No,” immediately provide the reinforcer activity for the earned duration and log duration on the data collection sheet.

Repeat this process at least one more time during the day. Note, students must not have access to the reinforcers without earning them through activity.

Fixed Interval Schedule of Reinforcement:

During days 1-7, student will earn three minutes of screen time for each minute of activity. During days 8-14, student will earn two minutes of screen time for each minute of activity.

During days 15-31 and maintenance, student will earn one minute of screen time for each minute of activity.

I did

Exercise

Superhero Workout minutes	Weights minutes	Wii Exercise minutes
Yoga minutes	Walk/Run minutes	Dance Video minutes

I Earned minutes of:

Music Videos

Youtube

Video Games

First Then

Screen Time

Exercise

Procedure Part Two:

Step 1: Each morning, as part of his morning ADL routine, the student will don his watch-style, electronic activity tracker/pedometer.

Step 2: Each evening, as part of the bedtime preparation routine, the parent will prompt the child to check the total number of steps walked on the fitness tracker.

Step 3: The student will write the total daily steps on his My Steps log. Parent will log the total steps on the data collection sheet.

Step 4: If the total daily steps exceed 2,500, the parent will give the child 50-cents. If the total steps exceed 5,000, the parent will give the child $1.00.

Step 5: Student will be allowed opportunities to exchange the accumulated money for reinforcer of his choice.

Fixed Ratio Schedule of Reinforcement: Student will earn 50-cents for every day steps exceed 2,500 and $1.00 for every day steps exceed 5,000.

My Steps

Date	Total Steps	How much did I earn today?

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Introduction

Autism Spectrum disorder is a range of neurological disorders that have deficits in social functioning and communication, with presentations of stereotypic and/or repetitive behaviors (American Psychiatric Association, 2013). In 2020, the number has grown to 1 in 59 children in the United States has ASD (CDC, 2020) with the diagnosis steadily increasing each year.

However, those with high functioning autism may lack social skills and may have challenges when it comes to interpersonal relationships along with understanding emotions. While individuals with ASD on the lower functioning end often have physical limitations, they may lack speech, while having the inability to relate socially with others (Westbrook, et al., 2012 ). The deficits associated with autism spectrum disorder differ drastically and regardless of the IQ scores, the individuals remain underemployed or unemployed once graduating from high school (Howlin, Goode, Hutton, & Rutter, 2004).

Which in turn means the individuals are not able to financially support themselves and are dependent on others which affects their overall quality of life. When an individual does find employment, the job quality is often lowered then their typically developed peers. (Howlin,

2000; Howlin et al.,2004 ; Jennes‐Coussens, Magill‐Evans, & Koning, 2006). The lowest

employment rates recorded are for the individuals on the autism spectrum (Burke et al. 2010). By allowing an individual with autism to gain meaningful employment not only will it all the individual to gain independence by financially supporting themselves, but can also allow the individual to express their interests in the field. With the result being a better quality of life for the individual.

Running Head: Vocational Tasks

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For years, the focus of research has been on early interventions for those with ASD. Leaving problems when the individuals grow and lack of focus on the teenage years or adulthood. Employment is very limited for those with ASD (Hendricks and Wehman 2009).

In 2011 it was estimated that 90% are unemployed or underemployed, with 80% remaining dependent on their parents (Gerhardt and Lainer, 2011). Individuals with Disabilities Education Act (IDEA) is federal legislation that protects the rights of individuals are receiving special education services, including those with autism. IDEA explicitly states that appropriate postsecondary goals, education or employment, based on the individuals’ interests and strengths ought to be included in the students ’Individualized Educational Plan (IEP) and should be receiving support to meet these goals. However, findings show only 25% of individuals with ASD have employment (Holwerda et al. 2012). In a recent study, with high — functioning ASD individuals only 49% had paid employment and 36% were on social security benefits out of 169 individuals (Barneveld et al. 2014). The social and communicative difficulty for individuals with ASD may be a factor for the limited employment opportunities and can impact adaptive functioning (American Psychological Association 2000). Typical employment training methodology may hinder the achievement of understanding the role which negatively impacts employment. Also, most employment requires an understanding of social cues and the ability to positively interact with others. Individuals who find this challenging may have difficulty keeping the job. While other individuals may have comorbid diagnoses, physical limitations, behavioral issues, and health limitations that may hinder the requirements of the employment ( Walsh, Lyndon, & Healy, 20014). Vocalizations, sensory difficulties, serotyped motor movements, or preservation of keeping the same routines are behavioral issues associated with ASD (Schall, 2010). Comorbid disorders are when two or more disorders or illnesses are occurring in the same

person. Gastrointestinal disorder, intellectual disabilities, epilepsy, and anxiety are commonly affiliated with ASD (e.g., Hofvander et al. 2009; Lugnegård et al. 2011). On the contrary, ASD individuals may possess a skill and/or traits that are highly desired by the employer. Such as some individuals can be highly focused on a given task and thrive in a structured environment where their routine is consistent.

Most individuals with autism just want to be employed and strive to receive some sort of independence. If there was more of a focus on helping these individuals with ASD more so in their teenage years, then the numbers might end up looking a little different. Those with ASD might not be the most underemployed with disabilities. If there was more of a focus within the transitioning stage and maybe a little less focus during earlier stages, then there might be more signs of success when it comes to employment opportunities for those adolescents who are on the spectrum.

Researchers before emphasized on overcoming social deficits and limiting maladaptive behavior in individuals with autism (Barnhill, Cook, Tebbenkamp, & Myles, 2002). A recent shift has been to focus on assessing and teaching job-related social skills to individuals with ASD. (Grob, Lerman, Langlinais, & Villante, 2019). With the focus on job-related social skills, there is a limited focus on independence. Many individuals with ASD need prompts or reminders to complete vocational tasks which can come off as unappealing to employers and make it difficult to retain employment.

Challenges include things such as initiations, prompt dependence, and generalization (Lora, Kisamore, Reeve, and Townsend, 2009). These challenges include task initiation with social interactions and can be very challenging for those who have ASD. This is because they may have a lot of trouble planning what they have to do to finish an activity. They also lack

motivation and their knowledge of what is expected of them is very poor. People with ASD also have trouble with being independent on their own and do better with responding to orders given by family members and caretakers. However, this may be difficult in jobs where prompt behavior is not always possible and the employee needs to show some signs of autonomy while on the job. This will be rather difficult for individuals with ASD to retain jobs because there will be times where they need to show up to work and know what needs to be done, there will never be on the job training given during every shift for every day. After a while, they will need to adjust to a routine while at work.

By implementing an activity schedule you are providing independence in a range of categories. Such as social, leisure, academic, and vocational tasks ( Lora, Kisamore, Reeve, & Townsend, 2019). Activity schedules are a series of pictures or words that indicate to the student was is expected next. By providing an activity schedule, it provides structure and independence to the student to see what is the next step without being dependent on prompts to help transition to the next step. Research has also demonstrated that using an activity schedule has increase independence on task engagement while decreasing maladaptive behaviors (Carson, Gast, & Ayres, 2008). Activity schedules are beneficial to teachers, employers, and therapists working with individuals with ASD. The activity schedules provide a non-invasive strategy while increasing independence (Carson, Gast, & Ayres, 2008).

Expanding job opportunities for individuals with ASD is highly needed. Recently, federal legislation passed supporting investment in green jobs which is a great opportunity for individuals to learn about their environment while being employed. Beekeeping is one of the types of sustainable employments ( Sances, Day-Watkins, & Connell, 2019). Research has suggested that implementing an activity schedule while providing contingent reinforcement

helped increased the numbers of independent completed steps ( Sances, Day-Watkins, & Connell, 2019). Employers seem to accept the use of activity schedules. Research has shown that employers perceive activity schedules to decrease supervision and has provided a positive behavior change (Koyama & Wang, 2011). Copeland & Hughes (2000) found a benefit of the activity schedule is that stimulus control can be carry-over from an adult to a picture. The picture can direct the behavior without the presence of a supervisor. Research has suggested that individuals with autism will identify the picture prompts and can perform the tasks in a set of complex behavior chains ( Koyama & Wang, 2011). The less supervision by employers needed will increase employment, job security, and over the quality of life for individuals with an autism spectrum disorder.

Method

Participants, Settings, and Materials

Dominic is a 16-year-old male and has a comorbid diagnosis of autism spectrum disorder, attention deficit hyperactivity disorder, severe intellectual disability, and anxiety. Dominic lives at home with his mother and sister who is 20 years old, as well as visitations with his dad twice a week. Dominic receives home-based services; two hours on Wednesday and four hours on Saturdays. During the day Dominic attends a day school that is specifically for individuals with Autism Spectrum Disorder. At school, the classroom consists of six students and six staff members, one for each student. Dominic is limited in holding conversations but can request basic needs such as leisure activities, food, drinks, and certain wants and desires. He is orally able to communicate yes and no questions but is not always accurate in relaying accurate information.

Dominic is independent in self-care skills and does not require any prompting or assistance.

Sessions took place in Dominic’s job site, which was at a pizza parlor. There were twenty sessions total with a variation between three staff members. Staff received training before the sessions began. The three staff members had experience with working with Dominic and had been working with Dominic between one to six years. Materials consist of a datasheet, pens, and an activity schedule. Also, materials consist of pizza boxes, menus, cleaners, rags for the table, and an iPad that had recorded video modeling.

Staff Training

The three staff for the sessions consisted of two staff members that were from Dominic’s day school, and one was from the home-based team. The staff members were required to watch a video modeling for each one of these tasks: folding pizza boxes, washing down menus, and table washing. The staff worked with a BCBA that was pretending to be a student to make sure that the prompting methods were being implemented correctly. The staff was able to implement the treatment with Dominic once they reached 100% on a treatment fidelity sheet.

Response Measurement

Dominic was taught vocational tasks such as folding pizza boxes, cleaning menus, and washing down the tables. A multiple probe design with prompt fading was implemented. The independent variable was the video modeling procedure. The dependent variable was Dominic’s ability to complete each of the steps within the task analysis chain independently.

Procedure

The prompt fading method was provided using video prompting. Five sessions were provided in four weeks starting at 3:00 pm at Dominic’s workplace, the pizza parlor. Each session was one hour long in four weeks, making a total of twenty sessions with 20 hours total at the end of the study.

Baseline

At the beginning of each session and before any instructions were given, an iPad was set up on a counter at the front of the pizza parlor. It was open to a video on the specific video task at hand. Dominic would press the play button to begin the video. One of the three trained staff members would state, “Dominic it’s time to start work”. Given Dominic’s past, he knows to go to the computer to clock in for his shift to begin. Praise was given after each correct task on the task analysis. There were no consequences given. Based on the data collected from the baseline, we were able to recognize the prompt level from each step of the task analysis.

Video Prompting

Video modeling was used as a form of chaining, which depicts each step of the vocational tasks; Folding boxes, wiping tables, and cleaning menus. The person in the video modeling was a novel model to Dominic. The model was looking at the video camera straight on for all three of the tasks. The model spoke each step in the task analysis before displaying each behavior. There was a separate clip of each step of the task analysis. At the end of each step, there was the time allotted for Dominic to complete the step before moving onto the next one.

There were 30 steps total for Dominic to complete.

When Dominic arrived, his first task was to clock in for the day. Staff would wait 10 seconds for the successful clock in. If Dominic did not clock in, the staff would use the prompt for that step on the task analysis. The prompt hierarchy was the least to most prompting, which consists of a video prompt, then to gesture prompt, then to light physical prompt, and then full physical prompt. Dominic then proceeded to go to the counter to turn on the video on the iPad by pressing play. After each clip, he’s expected to complete each step. Based on baseline data,

prompts were provided for each of the corresponding steps. A preference assessment was provided before the study which illustrated preferred reinforcers. Dominic’s had an array of three preferred reinforcers that he was able to choose from after the three tasks were completed.

Throughout the tasks, praise was provided on a fixed-ratio schedule of three.

Probes

A probe was conducted every five days at Dominic’s worksite; the pizza parlor. The probes indicated the level prompt for each step on the task analysis. If Dominic showed independence while completing a specific step, then the prompt was removed for that specific step.

Data Collection

Data was recorded using a task analysis sheet (Figure 1) which consisted of 30 steps of Dominic’s vocational skill routine. The accurate prompt level was listed next to the steps and was determined from the baseline data. A plus would indict the step was completed independently. A minus would mean the Dominic was unable to complete the step independently. When probe sessions were transpiring, if Dominic completed the step independently then the prompt would be changed. After each session, the total number of independent steps were recorded. The number of Dominic’s independent steps were then divided by the total number of steps listed within the task analysis to see the percentage of completed independently steps within each session.

Results

Figure 2 outlines the results of Dominic’s independent vocational skills within his job site; the pizza parlor. The steps completed independently are indicated by numerical data. Across 40 sessions, the data represents that multiple probe procedure was effective in teaching Dominic independent vocational tasks at his job site. Five probes were held within Dominic’s job site. The baseline probe indicated a 10% independence when completing his vocational skill task analysis. The probes showed an increase in independence skills. By session 10, Dominic was at a 50% independence and by session 20, was at 100% independence.

With a session being held daily, the data showed that independence skill progression was steadily increasing. From sessions 1- 10, independence increased by 40% and steadily keeps increasing. Stabilization did occur between sessions 12-14 but by session 15 independence was at 65%. Dominic showed an average of 100% independence by session 20. The multiple probe design was effective in teaching Dominic independence of vocational skills.

Discussion

This study shows you how the use of video prompting model can be effective in teaching vocational skills to an individual with an autism spectrum disorder. The rapid increase in independence was demonstrated at his work site; the pizza parlor. The study shows that variables such as staff or other employees did not play a factor in the results of the study. The interventions were still effective and an increase in independence was still gained. However, the consistency of the iPad and other materials may have had a factor in the success of Dominic’s independent skill.

Failure to observe the generalization of skills within different settings was a limitation of the study. Also, another limitation was baseline data could have been longer to truly analyze Dominic’s independence. Another limitation was the population size was only one individual, in which the study does not produce enough evidence on effectiveness across other individuals.

Next, a limitation would be conducting the study within one setting, by having another environmental setting, the data products would be different. Future research is needed to justify the findings of this study.

Appendix:

Figure 1: Vocational Skills Task Analysis

Vocational Skills Task Analysis

Student: Dominic

Target Behavior: Vocational Skills

Operational Definition: Any instance of Dominic completing a step within the task analysis without prompting.

SD:“ Dominic it’s time to start work”

Reinforcement: Tangible was given on FR3 schedule

Instruction : Put a plus (+) if Dominic completed the step independently or a minus (-) if Dominic did not complete the step in 10 seconds. If Dominic was given a minus (-) then provide the prompt level to complete the step.

Prompt Levels: V: Visual prompt; The video modeling was shown, no help from staff was needed. G: Gesture prompt; Staff exhibit some kind of gesture to get the desired response for the task. PP: Partial Prompt; Staff lightly guides Dominic to complete the desire response to the task. FP: Full Prompt; Staff hand over hand Dominic to complete the desire response to the task.

Staff: Date:

Steps	Current Prompt Level	Plus (+) or Minus (-)	Prompt Level Used
Folding Pizza Boxes
1. Get a pizza box
2. Fold the top of the pizza box
3. Fold the left side of the pizza box
4. Fold the right side of the pizza box
5. Push the sides up
6. Push the top of pizza box down into the bottom
Wiping down Menus
1. Collect menus at the front of the restaurant
2. Collect menus at the back of the restaurant
3. Collect menus on the side of the dining room
4. Go get a bucket with cleaner and a rag
5. Wipe down the front of the menu
6. Wipe down inside left side of the menu
7. Wipe down inside middle of the menu
8. Wipe down right inside side of the menu
9. Wipe down back right side of the menu
10. Wipe down back middle of the menu
11. Put menus back

Steps	Current Prompt Level	Plus (+) or Minus (-)	Prompt Level Used
Table Washing
1. Get a bucket with cleaner
2. Get rag
3. Remove the pepper shaker, put on seat
4. Remove the saltshaker, put on the seat
5. Remove the specials off table
6. Place the rag in the bucket — squeeze out the water
7.Start in left-hand corner
8. Then right-hand corner
9. Then go back and forth down table four times
10. Put the saltshaker back on the table
11. Put pepper shaker back on the table
12. Put specials back the on table
13. Empty bucket when done

Total Independent Steps:
Total Possible Steps:	30
Percent of Independent Steps Completed:

Figure 2

Percentage of Steps Completed Independently in Dominic’s Vocational Skills

Post Probe 3

Post Probe 1

Post Probe 4

Post Probe 2

Post Probe 5

100.0%

90.0%

80.0%

Percentage of Independent Steps

70.0%

60.0%

50.0%

40.0%

30.0%

20.0%

10.0%

0.0%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Sessions

Social Validity Scale

On a scale of 1-5, 1 being very poor and 5 being very good, how would you rate the following questions:

	1- Very Poor	2	3	4	5- Very Good
Was the procedure easy to understand?
Overall how satisfied are you with the teaching procedures used in this project?
How would you rate the prompting hierarchy?
How likely would you use this procedure?
How helpful was the introduction information for the procedure?

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,

Dishwashing Vocational Program

Student: John Doe
Objective: John will complete a TA for dishwashing with 80% accuracy in 8 out of 10 opportunities with fading staff support using a backward chaining procedure.
Materials: Data sheet, dish soap, dishes, sponge, drying rack	Suggested Prerequisites: Ready response, multi-step directions
Reinforcement: John may access a 5-minute break of choice after the successful completion of the program. No verbal praise or instruction should be given during the program
Prompt Hierarchy : Least to Most Physical Prompting on the target step 2 second delayed gesture, gesture, light physical, full physical prompts	Task Analysis Chaining Procedure: Steps for completing the task will be formatted as a task analysis. Each step will be scored on level of prompt needed to complete the step. The steps will chain together to form the completed task. All the steps except the last step of the chain will be full physical prompting, with the last step being the target step. When the target step reaches the mastery criterion, the next step in the chain will be added to the target. Mastery of step: 80% independence or better over 3 consecutive sessions. A baseline of the total task will be conducted before teaching to determine performance level. A baseline in other settings will be conducted after skill mastery to determine generalization of the skill.
Data Collection: · Ind, G, LP, FP based on most intrusive prompt needed · Percent Independent scored
Lesson Details : John should be able to thoroughly clean a sink full of dishes without direction from staff. In the event that John has not initiated the next step in the chain, staff will provide a prompt to initiate the next step.
Teaching Procedures:
Staff will present the SD “It’s time to wash dishes” to begin the task. John will approach the sink to show he is ready to begin. Each step will be completed with full physical prompting until the final step or target step is reached. John will attempt the step using least to most prompting to complete it. Once John has reached mastery criterion for step 20, he will move to completing steps 19 and 20. Program Mastery : John will move up in steps until steps 1-20 can be completed with 80% independence or better across 3 consecutive sessions across 3 different environments (school cafeteria, vocational lab sink, home economic room sink) Generalization : Once John has mastered the skill in the vocational lab setting with 3 consecutive sessions showing 80% or better, a probe in two other settings will be run. If John completes the skill in these settings with 80% accuracy or better the skill can be considered generalized.	Program Steps 1. Turn on sink 2. Wet the dirty dishes in the sink 3. Get the sponge 4. Wet the sponge with water 5. Turn off sink 6. Get dish detergent 7. Put detergent on sponge 8. Put detergent back 9. Scrub the dishes with the sponge 10. Get drying rack 11. Turn on sink 12. Rinse off sponge 13. Put sponge away 14. Rinse off dishes 15. Put dishes on drying rack 16. Turn off sink 17. Get paper towel 18. Dry hands 19. Dry counter 20. Throw paper towel away

Task Description: 1. John will approach the sink to show that he is ready to begin the task 2. John will turn on the sink with warm water regardless of the type of sink knob 3. John will wet the dishes that are dirty in the sink using the faucet 4. John will retrieve the sponge from the sponge holder near the sink 5. John will run the sponge under the warm water for 1-5 seconds to wet the sponge 6. John will shut off the water from the sink 7. John will retrieve the dish detergent from the caddy next to the sink 8. John will pour a quarter sized amount of detergent onto the sponge 9. John will return the detergent to the caddy 10. John will use the sponge to scrub the dishes in the sink until they are free of debris 11. John will retrieve the drying rack from under the sink 12. John will turn on the sink with warm water 13. John will rinse of the sponge he is using until there is no more soap 14. John will return the sponge to the sponge holder 15. John will rinse off the dishes until there is no more soap visible 16. John will put the dishes into the drying rack in an organized fashion 17. John will turn off the sink 18. John will get a paper towel from the dispenser next to the sink 19. John will dry his hands with the paper towel 20. John will wipe down the counter surrounding the sink with the paper towel 21. John will throw away the paper towel in a trash receptacle Error Correction : If John does not initiate a step or makes an error, staff will use least-to-most prompting to complete the step correctly. If John resists physical prompting mark a minus ( – ) in the box on the task analysis and ABC the instance.

Baseline Scores:

Baseline Skill	Baseline 1	Baseline 2	Baseline 3	Overall Percent
Total skill
Vocational Lab
School Cafeteria
Home Economic Room

Target	Date Introduced	# of Trials to Mastery	Date of Mastery
Step 20
Steps 19 & 20
Steps 18-20
Steps 17-20
Steps 16-20
Steps 15-20
Steps 14-20
Steps 13-20
Steps 12-20
Steps 11-20
Steps 10-20
Steps 9-20
Steps 8-20
Steps 7-20
Steps 6-20
Steps 5-20
Steps 4-20
Steps 3-20
Steps 2-20
Total Task Steps 1-20